Results are out from a key drug trial concerning one of the most important medical advances of the past decade – the arrival of safe and effective obesity treatments, in the form of weight loss jabs.
The trial was a comparison of the first such medicine, Wegovy (also known as semaglutide, or Ozempic when used for type 2 diabetes) with recent arrival Mounjaro (tirzepatide). Mounjaro caused the most weight loss.
In some respects, the result is not a surprise. Previous separate trials of the drugs, comparing each one to placebo injections, had already suggested a similar difference.
But the direct comparison was necessary, because the past trials could have had subtle differences that wrongly made one medicine look better than the other – for instance, the participants could have had more health complications. The head-to-head has confirmed that Mounjaro leads to more weight loss when all else is equal.
But we are unlikely to see Wegovy sales go into freefall – in fact, some people might be better suited to Wegovy, experts said at the European Congress on Obesity, held in Malaga, where the results are being discussed.
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After about one year of use, people taking Mounjaro had lost 20 per cent of their initial weight. People taking Wegovy had lost about 14 per cent.
But Wegovy is still a very effective drug, said Dr Louis Aronne, an obesity specialist at Weill-Cornell Medical College, who ran the trial. “The majority of people with obesity will do just fine on [Wegovy].”
Who needs to take Mounjaro?
People who are very obese may need Mounjaro to reach a healthy weight, said Dr Aronne. “It may be that people at a higher body mass index may do better with a more potent [drug].”
Serious side effects seem to be very rare for both Wegovy and Mounjaro. But the drug that is in Wegovy has a longer history of use, having been prescribed for type 2 diabetes since 2018. “That’s very reassuring,” said Professor Carel le Roux, an obesity specialist at Imperial College London. In fact, drugs that work in a similar way to Wegovy, mimicking the appetite-reducing hormone GLP-1, have been in use for two decades, supporting the idea that the basic mechanism is safe.
Mounjaro, on the other hand, mimics both GLP-1 and a second hormone called GIP, so it is less of a known quantity. “People that are really worried about longer-term outcomes can say [Wegovy] is a perfect drug for me,” said Professor Le Roux. “People who need more weight loss, might feel [Mounjaro] is perfect.”
Wegovy has revolutionised weight loss treatment (Photo: Tatsiana Volkava/ Getty Images/ Moment RF)Do the drugs have different effects on health?
With its longer history of use, there have now been several trials showing that Wegovy not only causes weight loss but also cuts the risk of heart attacks and strokes. It is the only weight loss drug to be approved for preventing heart disease in the UK.
“For cardiologists, for people who’ve had [heart attacks] they are focused on semaglutide,” said Dr Aronne. Health insurance companies may be willing to cover the cost of Wegovy but not Mounjaro.
In the new trial, more people got irritation at the site of injection with Mounjaro than with Wegovy – at 9 versus 0.5 per cent. Side effects included redness, pain and itching. But the number of people who quit their treatment as a result was about the same in both groups.
The trial was run by Eli Lilly, manufacturer of Mounjaro. “These data confirm [Mounjaro] as an important treatment option for people living with obesity and equip healthcare providers with critical insights to make well-informed treatment decisions as part of a comprehensive obesity care plan,” said Leonard Glass, Eli Lilly’s senior vice president of global medical affairs.
A spokesperson for Novo Nordisk, the manufacturer of Wegovy, said the firm was uncertain about the trial’s methods.
“We believe that treating obesity is about more than just a number on a scale and Wegovy is the only GLP-1 obesity medication approved to prevent major cardiovascular events such as cardiovascular death, heart attack, and stroke and thereby potentially save and prolong lives.”
Do other weight loss injections have different benefits?
Many more kinds of weight loss injections and tablets are in development, some of which may be more suitable for particular patient groups, said Dr Aronne.
For instance, some drugs seem to be especially helpful for people with fatty liver disease, while others help people keep their muscle while losing fat tissue. Those would be helpful for older people where loss of muscle is a concern, he said.
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